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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 8  |  Page : 1234-1239

Evaluation of Multidisciplinary Treatment Relationship between Orthodontics and Periodontology Departments by Examining Inter-Departmental Consultation Notes


1 Department of Periodontology, Faculty of Dentistry, Erciyes University, Turkey
2 Department of Orthodontics, Faculty of Dentistry, Erciyes University, Turkey

Date of Submission07-Sep-2020
Date of Acceptance12-Jan-2021
Date of Web Publication14-Aug-2021

Correspondence Address:
Dr. T Ozturk
Erciyes Universitesi, Dis Hekimligi Fakultesi B Blok Kat: 3 Ortodonti ABD 38039 Kayseri
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_553_20

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   Abstract 


Aims: The aim of this study is to evaluate the multidisciplinary treatment relationship between the two specialties of Dentistry, Departments of Periodontology and Orthodontics, by examining consultation request notes between the two departments. Materials and Methods: The consultation request notes of 1685 patients who were treated at Erciyes University Faculty of Dentistry were included in the study. All notes were analyzed retrospectively and divided into categories. While the consultation request notes of 446 patients from the Department of Periodontology (DP) to the Department of Orthodontics (DO) were evaluated, the consultation request notes of 1239 patients from DO to DP were evaluated. Pearson's Chi-Squared test was used in the cloud-based TURCOSA statistical software for the statistical analysis of the obtained data. Results: The highest number of requests for consultation from DP to DO was due to “Evaluation of the patient for orthodontic treatment (n = 203; 45.5%),” and the highest number of requests from DO to DP was “Gingival/Periodontal Treatment and Providing Motivation of Oral Hygiene (n = 558; 45.0%)“. It was observed that most patients for whom consultation was requested were women (P < 0.05). Conclusions: This study determined the most common reasons for consultation requests between DP and DO and the sex which was the most prevalent. It was concluded that requests were made for the expertise of the other department for problems that could not be solved by the first department.

Keywords: Consultation, multidisciplinary treatment, orthodontics, periodontology


How to cite this article:
Kurem I, Topsakal U, Ozturk T. Evaluation of Multidisciplinary Treatment Relationship between Orthodontics and Periodontology Departments by Examining Inter-Departmental Consultation Notes. Niger J Clin Pract 2021;24:1234-9

How to cite this URL:
Kurem I, Topsakal U, Ozturk T. Evaluation of Multidisciplinary Treatment Relationship between Orthodontics and Periodontology Departments by Examining Inter-Departmental Consultation Notes. Niger J Clin Pract [serial online] 2021 [cited 2022 Jan 19];24:1234-9. Available from: https://www.njcponline.com/text.asp?2021/24/8/1234/323864




   Introduction Top


The primary purpose of periodontal therapy is to restore the disrupted integrity of supracrestal tissue attachment, which consists of supracrestal connective tissue attachment and epithelial attachment and to maintain the state of health.[1] Pathological tooth migrations may be seen due to a missing tooth or loss of supporting periodontal tissues. This situation may cause median diastema or diastema development in the incisors with or without proclination, rotation, or tipping of the molar and premolar teeth and a decrease in the vertical dimension with a collapse of the posterior occlusion.[2] Orthodontic treatment is required to solve these problems. Additionally, orthodontic treatment may facilitate management of various restorative and aesthetic problems related to broken teeth, overturned abutment teeth, malposed teeth, excessive interdental space, insufficient pontic spacing, excessive incisors, and diastema. Most physicians, based on their clinical experience, state that a “good” dentition and arch form may be more conducive to periodontal health than “bad” dentition with crowded and irregular teeth. Correct tooth position, arch form, and crown models make the idea of form and function synonymous.[3] This concept implies that restoration of a proper form will improve the function in direct proportion. Therefore, it suggests that teeth with a proper dental arch form and alignment will provide protection for supporting structures during normal functioning.[4] For this reason, a multidisciplinary approach is required while performing periodontal or orthodontic treatments. With the cooperation between specialties, orthodontic treatment contributes to protection of periodontal health, while periodontal treatment ensures the success of orthodontic treatment. Thus, the harmony between the two different branches ensures that treatment results are more positive and the health state is sustainable.

It is especially important to know the biological concepts between orthodontics and periodontology for the maintenance of oral and dental health. Fixed and removable appliances used in orthodontic treatment or a combination of these appliances can move teeth within the alveolar crest.[5] Changes in the periodontal ligament due to physiological or orthodontic tooth movements are perceived and regulated by periodontal cells.[6] During orthodontic treatment, some undesirable conditions that affect the periodontium may be observed. These are facilitation of retention of bacterial plaque and food residues due to orthodontic appliances and initiation of gingival inflammation, migration of the attachment to the apical when orthodontic bands are placed at the apical of the attachment level during the eruption of teeth, and pocket formation, whereas excessive forces may cause necrosis in the alveolar bone and the periodontal ligament during orthodontic force loading.[5],[6],[7],[8]

In some cases, applying orthodontic treatment as a multidiscipline while performing periodontal treatment may contribute to improvement of the following problems. Examples of this are elimination of bone defects and pockets due to malposed teeth, elimination of gingival inflammation caused by plaque involvement due to dental malposition, removal of irregular arcs for reconstructive surgery and repositioning of teeth for a better aesthetic look (such as gummy smile treatment).[2],[3],[5]

The aim of this study was to evaluate and compare the reasons and answers to the consultation notes used in communication between the orthodontics and periodontology departments to determine and evaluate the multidisciplinary relationship between the two departments.


   Materials and Methods Top


The ethical approval required to conduct our study was obtained from Erciyes University Clinical Research Ethics Committee (Approval No: 2020/412). In the study, there were 1044 women (mean age: 20.35 ± 9.55 years) and 641 men (mean age: 18.78 ± 8.67 years) who were treated at Erciyes University Faculty of Dentistry, Departments of Periodontology (DP) and Orthodontics (DO) between 2016 and 2020. Consultation request forms for a total of 1685 patients were evaluated, retrospectively. These forms included opinions between the two departments about the patient's current health status and advanced treatment that could be performed in the relevant discipline. The inclusion criteria in the study were as that (1) the patient applied to DO with a request for orthodontic treatment or to continue to be treated in DO, (2) it was thought that periodontal treatment was needed before or during orthodontic treatment, and with an explanatory reason, DP (3) consulted in written form to the orthodontics department for an explanatory reason, considering the need for orthodontic treatment before or during periodontal treatment, (4) a clear and detailed record of the patient's problem. The exclusion criteria in the study were as that (1) the patient was evaluated without writing a consultation note and (2) there was not enough explanatory information in the consultation note.

Our study was carried out using data belonging to patients in a specially designed commercial computer software ([Figure 1]; MedData Hospital Information Management System, V. 4, Ankara, Turkey) that is interactively used in all clinics within the dental hospital. The notes showing the reasons for the consultation request of all patients included in our study were evaluated one by one and categorized under the headings presented in [Table 1] and [Table 2] for each discipline. In order to evaluate the differences between the genders of the data obtained, a separate examination was made for male and female. The data for each category are presented as the number of patients (consultation notes) and in-column percentage for each gender and in total. In the evaluation of the consultation request notes, a single evaluation was made for each patient and similar requests belonging to the same patient were not included.
Figure 1: Sample image of the computer software, which is directed from the Department of Periodontology to the Department of Orthodontics and shows the consultation request note in the form of labial frenulum examination

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Table 1: Consultation request from Department of Orthodontics to Department of Periodontology and evaluation of the relationship between genders

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Table 2: Consultation request from Department of Periodontology to Department of Orthodontics and evaluation of the relationship between genders

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Statistical analysis

The age information of the patients is given as mean and standard deviation, and the categorical data are given as the frequencies of samples and percentages. Pearson's Chi-Squared test was used to determine the relationship of categorical variables with sex. The statistical evaluation of the data was performed using the TURCOSA (Turcosa Analytics Ltd Co, Turkey, www.turcosa.com.tr) statistical software. The statistically significant level was determined as P < 0.05.


   Results Top


After evaluation of all the forms, the reasons for requesting consultation from DO to DP were collected under nine subtitles [Table 1].

Among the two departments, it was determined that the department that most wanted consultation evaluation for the patients was DO (number of requests: 1239 patients/requests). While 743 of these patients were female (59.9%; 18.23 ± 6.42 years), 496 were male (40.0%; 17.82 ± 6.73 years) [Table 3]. There was a significant relationship between the patients examined and/or treated at DO and sex, due to the request for consultation with DP (P < 0.001; [Table 1]). When the reasons for consultation requests were evaluated, the most demanded was “Gingival/Periodontal Treatment and Providing Motivation for Oral Hygiene” (n = 558; 45.0%). When an evaluation was made between the sexes, regarding “Evaluation of Periodontal Health (female: n = 187, 25.2%; male: n = 115, 23.2%)” and “Evaluation of gingivectomy treatment (female: n = 140, 18.8%; male: n = 56, 11.3%)”, it was determined that the reasons for requesting consultation were higher in the females than in the males [Table 1].
Table 3: Demographic distribution of patients sent from Department of Orthodontics to Department of Periodontology for consultation request

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The reasons for requesting consultation from DP to DO were grouped under 11 subtitles [Table 2]. It was determined that the number of consultation requests from DP to DO was 446 patients/requests. While 301 of these patients were female (67.5%; 25.60 ± 13.28 years), 145 were male (32.5%; 22.05 ± 12.83 years) [Table 4]. There was a significant relationship between the patients who were examined and/or treated at DP and the reason for the consultation request to DO (P = 0.038; [Table 2]). When the reasons for the consultation requests were evaluated, the most demanded was “Evaluation of the patient for orthodontic treatment” (n = 203; 45.5%). When an evaluation was made between the sexes, regarding “Evaluation of the patient for orthodontic treatment (female: n = 144, 47.8%; boy: n = 59, 40.7%)” and “Periodontal splint application (female: n = 46, 15%, 3; male: n = 18, 12.3%),” it was determined that the reasons for requesting consultations were higher in the females than in the males [Table 2].
Table 4: Demographic distribution of patients sent from Department of Periodontology to Department of Orthodontics for consultation request

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   Discussion Top


The phenomena of health and illness have been an important part of human life since the beginning of human history and affected by social changes.[9] Depending on social changes, the concept of health was defined by the World Health Organization (WHO) in 1948 as “Not only the absence of disease or disability, but a complete state of well-being in terms of spiritual, physical and social aspects.”[10] Thus, socioeconomic well-being has taken place as an integral part of health. Nowadays, it is seen that there is a significant increase in the number of patients who apply to our clinic with the need for aesthetic treatment due to aesthetic concerns. In oral health, the demand for orthodontic treatment, which creates aesthetic smiles with the individual's own natural teeth, is increasing. When the data for our study were examined, it was seen that the number of female patients in the sex distribution was significantly higher than the male patients in patients referred from DO to DP and from DP to DO. The data of our study were compatible with the literature.[11] This situation showed that the need for the women to be treated with aesthetic expectations was higher than the men. In the literature, it is emphasized that, before starting orthodontic treatments, periodontal treatments of patients should be completed, and periodontal health should be very good by providing very good oral hygiene training.[12],[13] When the data of our study were examined, approximately 70% of the patients who were referred from DO to DP consisted of patients who were asked to evaluate and provide periodontal health and oral hygiene motivation. These data were compatible with periodontal health provision before orthodontic treatment requested in the literature.[2],[12],[13] The appliances used during orthodontic treatment (Bracket, band etc.) increase the retention of dental plaque and food residues.[7] There are studies indicating that this situation leads to the loss of periodontal attachments and gingival inflammation.[14],[15] Chronic inflammation of the gums occurs due to the increase in the uptake of dental plaque and food residues.[16]

In accordance with the literature, the patients referred for excision and evaluation of gingival growths that occurred during orthodontic treatment constituted 18.9% of all the patients referred to PD from OD. This shows that periodontal health provided before orthodontic treatment was not protected. Accordingly, if it is determined that oral hygiene is disrupted between orthodontic treatment sessions, it will be appropriate to refer the patient to PD before gingival hyperplasia occurs. Other reasons, in consultations from OD to PD, are to expose the crown surgically when an impacted tooth cannot grow,[17] request for fiberotomy to prevent recurrence of rotated teeth,[18] evaluation of implant spaces and evaluation of the labial or lingual frenulum.

In our study, 5.8% of the patients referred from PD to OD were orthodontic evaluations for implant restorations, because, due to tooth deficiencies, crowding or over-rotated teeth can be corrected with simple orthodontic movements.[19] Thus, it is possible to apply implant treatment in the correct position. In the study of Paolone and Kaitsas, the authors recommended the use of simple regenerative techniques in areas with bone destruction, periodontal defects and implant treatment by creating orthodontic regeneration directed by orthodontic tooth movements.[20] They reported that, this way, the periodontal morphology can be improved by changing orthodontic movement.[20] Furthermore, since the growth of the facial skeleton and dental arches continues significantly in the first two decades of life, dental implant treatment is recommended after the age of 20.[21] Clinical studies on dental implants to be performed in young patients are still limited, and therefore, these are recommended to be performed after the age of 20.[21],[22] Additionally, in order to be able to apply implant treatment to patients who have lost teeth at an early age (due to dental trauma, dental agenesis, etc.), it will be appropriate to perform growth and development analysis before the implant is applied.[23] This is because problems may arise due to craniofacial growth that has not been completed at an early age.[24]

In our study, it was seen that mobility assessment due to crowding constituted 2.9% of the patients referred from PD to OD. The etiological cause of occlusal trauma had to be eliminated.[25] Occlusal traumas caused by dental malposition may lead to increased mobility in the teeth, enlargement of the periodontal ligament space, gingival recession, and angular bone loss.[25],[26],[27],[28],[29],[30] For this reason, it is very important to solve occlusal traumas caused by tooth malposition with a multidisciplinary treatment. In the literature review by Consoli et al., it was reported that the progression of periodontal diseases decreased, and the treatment results of the disease improved with removal of occlusal traumas in the mixed dentition period.[30]

Thus, maintenance of periodontal health is necessary. Additionally, other reasons for consultation from PD to OD included lingual retainer repair, splinting to reduce the mobility of teeth by supporting each other, removing arch wires to make periodontal treatments more effective, postponing orthodontic treatment, and planning tooth extraction.


   Conclusions Top


In order to achieve successful results in dentistry applications, a multidisciplinary treatment plan is required. Thanks to the multidisciplinary approach between branches, orthodontic treatment contributes to protection of periodontal health, while periodontal treatment ensures the success of orthodontic treatment. Thus, the harmony between the two different branches ensures that the treatment results are more positive, and the health state is sustainable. It may be predicted that the quality of the treatment offered to patients will increase by increasing the multidisciplinary relationship.

Statement of ethics

The study has been approved by the Erciyes University Local Ethic Committee (Kayseri, Turkey; Approval no: 2020-/412). All procedures conducted in this retrospective study, which includes data on human participants, were carried out in accordance with the ethical standards of institutional clinical research ethics unit and the ethical standards contained in the 1964 Helsinki Declaration.

Informed consent

Informed consent was obtained from all patients before orthodontic and periodontal treatments.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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